Tuesday, May 5, 2009

Obama: health care plan will make suggestions, not hand out directives?

THE PRESIDENT: ... there’s always going to be an asymmetry of information between patient and provider. And part of what I think government can do effectively is to be an honest broker in assessing and evaluating treatment options. And certainly that’s true when it comes to Medicare and Medicaid, where the taxpayers are footing the bill and we have an obligation to get those costs under control.

NYT: And right now we’re footing the bill for a lot of things that don’t make people healthier.

THE PRESIDENT: That don’t make people healthier. So when Peter Orszag and I talk about the importance of using comparative-effectiveness studies as a way of reining in costs, that’s not an attempt to micromanage the doctor-patient relationship. It is an attempt to say to patients, you know what, we’ve looked at some objective studies out here, people who know about this stuff, concluding that the blue pill, which costs half as much as the red pill, is just as effective, and you might want to go ahead and get the blue one. And if a provider is pushing the red one on you, then you should at least ask some important questions.

NYT: Won’t that be hard, because of the trust that people put in their doctors, just as you said? Won’t people say, Wait a second, my doctor is telling me to take the red pill, and the government is saving money by saying take the blue —

THE PRESIDENT: Let me put it this way: I actually think that most doctors want to do right by their patients. And if they’ve got good information, I think they will act on that good information.

Now, there are distortions in the system, everything from the drug salesmen and junkets to how reimbursements occur. Some of those things government has control over; some of those things are just more embedded in our medical culture. But the doctors I know — both ones who treat me as well as friends of mine — I think take their job very seriously and are thinking in terms of what’s best for the patient. They operate within particular incentive structures, like anybody else, and particular habits, like anybody else.

And so if it turns out that doctors in Florida are spending 25 percent more on treating their patients as doctors in Minnesota, and the doctors in Minnesota are getting outcomes that are just as good — then us going down to Florida and pointing out that this is how folks in Minnesota are doing it and they seem to be getting pretty good outcomes, and are there particular reasons why you’re doing what you’re doing? — I think that conversation will ultimately yield some significant savings and some significant benefits.

This is, frankly, a disturbingly Orwellian segment of NewSpeak.

By saying most doctors actually want to do right by their patients, the President is also implying that many do not.

And since there is an asymmetry of information between patients and doctors, government needs to step in and mediate.

But the only example he gives is where a doctor or doctors might be prescribing a medication that's too expensive, and not where a doctor might be under-medicating. Moreover, he's saying that in any system in which the government is spending its own money--Medicaid, Medicare, or some future government-funded system--we have an obligation to get those costs under control.

It's all very sensitively put here: the government is going to open a conversation about what treatment methods work, so that the patients can be better informed.

But the reality is again that if the government is footing the bill, the President expects the government to keep those costs under control, which--ultimately--means the government's ability to intervene in treatment decisions in pretty much the same way that your health insurance company does now.

This is, unfortunately, a carefully crafted piece of anti-intellectualism: doctors are either dupes or tools; you do not have the ability to make your own decisions without help; the government is going to consult people who might know about this stuff and tell you what's good for you.

5 comments:

Anonymous
said...

"But the only example he gives is where a doctor or doctors might be prescribing a medication that's too expensive,"

Steve, I get into this with Blue Cross all of the time. I take Lipitor for my cholesterol. I am in fact a high-risk patient as I have had previous heart episodes (most serious of all being clinically dead about 13 years ago). Although there are cheaper medications for cholesterol lowering out there, it took the Dr. and I over two years of trial and error to get my total cholesterol down to where it is today near 100. Considering my past medical situation, I'm not interested in changing any of my medications (plavix, atenelol,lipitor, niaspan and aspirin) that I properly credit for allowing me to live way past 40 years old (my life expectancy as my cardiologist gave me when I was 33). Although I would be considered a proponent of universal health care, I do wonder how the government plans to keep costs down. Sometimes the expensive medicine is just better

Steve parses: "This is, unfortunately, a carefully crafted piece of anti-intellectualism: doctors are either dupes or tools; you do not have the ability to make your own decisions without help; the government is going to consult people who might know about this stuff and tell you what's good for you."I don't get that from Obama's quoted comments at all.

For example, if the FL docs charge 25% more than the MN docs and get the same outcomes, Obama wants the government to act as an overseer in order to get to the bottom of this discrepancy. I agree! This is a needed role for the government to play, to cut costs and to encourage good outcomes.

For example, if the FL docs charge 25% more than the MN docs and get the same outcomes, Obama wants the government to act as an overseer in order to get to the bottom of this discrepancy. I agree! This is a needed role for the government to play, to cut costs and to encourage good outcomes.

When has government ever actually CUT costs? And "encourage good outcomes" based on whose definition of "good?"

Maybe the cost of living is higher in FL than MN?? Maybe that has something to do w/costs? After all, if gov. is supposed to "cut costs," maybe it can lower the cost of living in Manhattan to, say, what it is here in DE?

You are complaining about something that private insurance companies do all the time. Where is your complaint about them?

Besides, let's be honest now. If the government didn't institute a quality control program, you would have a fit about flagrant, excessive government spending w/ no one watching the bottom line. You have it fixed nicely so you can have it both ways.

DanaI said in the post that it would be the same thing insurance companies do now.

What I object to in this piece is the intellectual dishonesty of labeling this as a 'conversation' when it is in reality going to be a regulation.

It bothers me immensely when the President makes something sound cooperative and voluntary to win support, full well knowing it won't be.

Had he said, "We're going to put together a program that investigates cost-effectiveness of X types of medications and then requires physicians to justify on a case-by-case basis if they use the more expensive meds," then I would not necessarily have liked the plan, but I would have given him marks for honesty.